Hubungan antara Rasio Neutrofil Limfosit dengan Kejadian Penyakit Arteri Perifer Ekstremitas Bawah pada Penyandang Diabetes Melitus Tipe 2

Krishna Adi Wibisana, Imam Subekti, Dono Antono, Pringgodigdo Nugroho

Abstract

Pendahuluan. Penyakit arteri perifer (PAP) ekstremitas bawah merupakan salah satu komplikasi makrovaskular DM tipe 2 yang memiliki angka morbiditas dan mortalitas yang tinggi. Proses inflamasi telah diketahui berperan dalam terjadinya PAP pada penyandang DM tipe 2. Rasio neutrofil limfosit atau neutrophil lymphocyte ratio (NLR) telah digunakan sebagai penanda inflamasi kronik. Penelitian ini dilakukan untuk mengetahui hubungan antara NLR dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2 di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta.

Metode. Studi potong lintang dilakukan pada subjek penyandang DM tipe 2 yang menjalani pemeriksaan ankle brachial index (ABI) di poliklinik divisi Metabolik Endokrin RSCM periode Oktober 2015 – September 2016. Didapatkan 249 subjek penelitian yang memenuhi kriteria inklusi dan eksklusi. Dilakukan pengambilan data sekunder dari rekam medis mengenai data ABI, NLR, data demografik serta faktor perancu. Subjek dinyatakan menderita PAP ekstremitas bawah jika memiliki nilai ABI ≤ 0,9 dengan pemeriksaan probe doppler. Data NLR kemudian dikategorikan berdasarkan median nilai NLR dan dicari hubungan nilai NLR dengan kejadian PAP ekstremitas bawah. Uji chi square digunakan untuk analisis bivariat dan regresi logistik digunakan untuk analisis multivariat.

Hasil. Penyakit arteri perifer ekstremitas bawah ditemukan pada 36 subjek (14,5%). Didapatkan nilai median NLR total sebesar 2,11. Nilai median NLR didapatkan lebih tinggi pada kelompok PAP daripada tanpa PAP (2,46 vs. 2,04). Terdapat hubungan yang bermakna antara nilai NLR ≥ 2,11 dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2 (PR 2,46, IK 95% 1,23 – 4,87; p=0,007). Dengan menggunakan uji regresi logistik, diketahui bahwa hipertensi merupakan variabel perancu.

Simpulan. Terdapat hubungan antara rasio neutrofil limfosit dengan kejadian penyakit arteri perifer ekstremitas bawah pada penyandang DM tipe 2 di RSCM.

Kata Kunci: Diabetes melitus tipe 2, Inflamasi kronik, Penyakit arteri perifer ekstremitas bawah, Rasio neutrofil limfosit

 

Relationship between Neutrophil Lymphocyte Ratio and Lower Extremity Peripheral Artery Disease in Patients with Type 2 Diabetes Mellitus

Introduction. Lower extremity peripheral artery disease (PAD) is one of diabetic macrovascular complication which has high rate of morbidity and mortality. Chronic inflammation has been known to have a role in the pathogenesis of PAD in diabetic patient. Recently, neutrophil lymphocyte ratio (NLR) has been used as a marker of chronic inflammation. This study aimed to determine the relationship between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patient in Cipto Mangunkusumo hospital.

Methods.  A cross sectional study was conducted on 249 patients with type 2 diabetes mellitus who underwent ankle brachial index (ABI) examination at Metabolic and Endocrinology Divison in Cipto Mangunkusumo Hospital between October 2015 – September 2016. The data were retrospectively collected from medical record. Lower extremity PAD was defined as having ABI value ≤ 0,9 by probe Doppler examination. Neutrophil lymphocyte ratio was categorized based on the median value and the relationship with lower extremity PAD were determined. Chi square test was used for bivariate analysis and logistic regression was used for multivariate analysis against confounding variables.

Results. Lower extremity peripheral artery disease was found in 36 subject (14.5%). Median of NLR was 2.11. The median value of NLR was found higher in subjects with lower extremity PAD than without PAD (2.46 vs 2.04). There was an association between NLR value ≥ 2.11 and lower extremity PAD in type 2 diabetic patient (p=0.007; PR 2.46 and 95% CI 1.23 – 4.87). By using logistic regression, it was known that hypertension was the confounding variable.

Conclusion. There is an association between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patients in Cipto Mangunkusumo Hospital.

 

Keywords

Chronic inflammation, Lower extremity peripheral artery disease, Neutrophil lymphocyte ratio, Type 2 diabetes mellitus.

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